Caffeine Cuts Nocturnal Hypoglycemia in Diabetics

Caffeine intake at levels typical of normal consumption is associated with a significant reduction in nocturnal hypoglycemia in patients with long-standing type 1 diabetes. Lead investigator Dr. Tristan Richardson, stated that, "The fear of nocturnal hypoglycemia is consistently the greatest fear that patients bring up at the clinic." "The influence of a common everyday drug such as caffeine on reducing the amount of time with hypoglycemia, especially at night, is interesting, and has never been suggested before."

Dr. Richardson of Royal Bournemouth Hospital in the UK and colleagues note that in previous studies they showed that moderate caffeine intake can augment symptomatic and hormonal responses to mild hypoglycemia.

To investigate further, the researchers conducted a double-blind study of 19 patients with long-standing type 1 diabetes. They were put on a low-caffeine diet, containing less than 50 mg of caffeine per day, for 2 weeks. The subjects were then randomized to receive two 250 mg caffeine capsules twice daily or placebo.

Continuous interstitial glucose sensing was used for the last 48 hours of each 2-week period and Holter monitoring was employed to assess heart rate variability.

In the caffeine group, the mean duration of nocturnal hypoglycemia was 49 minutes. Without caffeine, it was 132 minutes. There was no overall correlation between reduced heart rate variability and hypoglycemic events.

"The underlying physiological cause remains unclear," continued Dr. Richardson, "and is not likely to be due to augmentation of autonomic function, another benefit of caffeine. It may be related to an alteration in non-REM sleep, another well known side-effect of coffee, and this warrants further study."

"The use of caffeine," he concluded, "may be one option worth trying in an attempt to reduce the frequency and length of hypoglycemia."

Diabetes Care 2005;28:1316-1320.

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FACT:
METABOLIC MEMORY: TIGHT CONTROL YEARS AGO HELPS TODAY: EDIC, the follow-up study of the DCCT, continues to provide startling news, none more so than the concept of "metabolic memory" – the notion that tight blood glucose control for an average of 6 years, even though followed by 10 years of less intensive control, still reduces your risk of diabetes complications all these years later compared to those who were originally in the 6-year control group but then improved their control somewhat in the subsequent 10 years. The benefits of that 6-year period of tight control continue to be reported, such as the reduced incidence of complications including retinopathy (#919). But how does the body "remember" that period of intensive control? Based on a comparison of skin biopsies of 215 people in both groups, researchers have found that those who had the highest level of glycation products 10 years ago have had more severe progression of complications, particularly retinopathy and nephropathy – strong evidence that those products may have something to do with causing the complications (#925). (Glycation products are produced by glucose reacting chemically with collagen without the need for enzymes, the best example of this being glycated hemoglobin, i.e. A1C.) Importance: Researchers now have more reason to look for ways to prevent or inhibit the reaction of glucose with proteins as a way of preventing the development of complications even in people whose blood glucose levels remain too high despite therapy. Research is already underway to find drugs to help prevent this reaction.

Presented June 12, 2005 at the ADA 65th Scientific Sessions. Abstract 919 and 925

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